Amendments to International Health Regulations Focus on Accountability, Compliance and Equity
Members of the South African National Defence Force patrol a taxi rank in Johannesburg during the country’s imposed lockdown.

Proposed amendments to the World Health Organization’s (WHO) International Health Regulations (IHR) focus on improving accountability and compliance, according to Director General Dr Tedros Adhanom Ghebreyesus.

Speaking at the start of last week’s meeting of the IHR review committee, Tedros said that he expected a report from the committee, which is considering the amendments, by last Friday.

The WHO did not respond to a Health Policy Watch query about whether this report would be made public, but it is expected to be considered by the WHO’s executive board meeting that starts at the end of the month.

By late December, over 300 amendments had been proposed by member states to the IHR, which provides the global legal framework of countries’ rights and obligations in public health emergencies.

The IHR set out the rights and obligations of countries in health emergencies, including the requirement to report public health events and the criteria for a  “public health emergency of international concern”. 

But during the COVID-19 pandemic, it became clear that the regulations, adopted in 2005, were inadequate. Major shortcomings of the regulations include the lack of urgency of the reporting process, that they don’t enable the WHO to get immediate access to sites of outbreaks, and the silence on equitable access to pandemic-mitigating products.

Improving pandemic prevention

“The proposed amendments reflect the critical need to strengthen the IHR to improve prevention, preparedness, and response to public health events that carry a risk of international spread,” said Tedros last week at the start of the IHR review committee’s meeting.

“The committee has identified several cross-cutting themes, including equity, transparency, trust, sovereignty, collaboration, and assistance, with the overarching goal of protecting public health,” he added.

“In particular, the committee noted a strong intention in the proposed amendments towards strengthening accountability and compliance with the regulations.”

The committee’s report will be submitted to the Working Group on Amendments to the IHR, which will submit the final amendment proposals to the Tedros. He then has to forward these to member states at least four months before the 2024 World Health Assembly.

Africa wants equity

The WHO Africa region, India, Bangladesh and Malaysia want Article 3 of the IHR, which sets out the principles for implementing the regulations, to be amended to equity and solidarity.

Detailed analysis of the 55 developing countries’ proposals on equity has been published by Third World Network (TWN). 

These include the inclusion of equitable access to the health products, technologies and know-how; health systems strengthening, and an access and benefit sharing mechanism for genetic material.

​​Other amendments from African member states have focused on intellectual property, licensing, transfer of technology, and know-how, as summarised by Knowledge Ecology International.

The key amendment in this regard, proposed by Eswatini on behalf of the WHO Africa region, is for the inclusion of a new article on Access to Health Products, Technologies and Know-How. 

According to this proposal, once a public health emergency of international concern has been declared, there should be “exemptions and limitations to the exclusive rights of intellectual property holders” to  “facilitate the manufacture, export and import of the required health products, including their materials and components”.

Conspiracy theories

In tandem with updating the IHR, the WHO is in the process of negotiating a pandemic accord to guide future pandemics, and this too will be tabled at the 2024 World Health Assembly.

Both processes have been the focus of conspiracy theorists, who allege that they are part of a secret WHO campaign to increase its power and undermine member states’ national sovereignty.

These claims, given legs by a hodgepodge of anti-vaxxers and right-wing opponents of the WHO, usually intensify on social media whenever there are important meetings and milestones, as happened last week to coincide with the review committee’s meeting.

Image Credits: Mstyslav Chernov/ Wikimedia Commons, Flickr: IMF Photo/James Oatway.

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